Vitro Fertilization Research Articles

Endometrial scratching before euploid embryo transfer: a case-control study.

To evaluate the effect of endometrial scratching on in vitro fertilization (IVF) success rates in women undergoing frozen embryo transfer with preimplantation genetic testing for aneuploidy (PGT-A). Biopsy was performed at oocyte retrieval in cases and compared to those who did not undergo scratching (controls). Endpoints included pregnancy loss, total pregnancy, clinical pregnancy rate (CPR), ongoing pregnancy rate/live birth rate (OPR), and the incidence of chronic endometritis (CE). Women in case and control groups had similar characteristics, such as age, body mass index, and parity. Overall total pregnancy rate was 82.43% following single euploid embryo transfer in cases compared to 85.7% in controls (p = 0.57; OR = 1.27; 95% CI = 0.565 to 2.78). CPR was 73.3% and 76.2% (p = 0.62; OR = 1.18; 95% CI = 0.594 to 2.29), and OPR between groups was 64.8% and 72.3% (p = 0.28; OR = 1.42; 95% CI = 0.74 to 2.7). First trimester loss rate was similar at 16.9%% and 15.5%%, respectively (p = 0.82). Subjects who underwent scratching closer to their frozen embryo transfer (≤ 3months) had a similar overall pregnancy rate to those with a longer delay between retrieval and frozen embryo transfer (> 3months 81.4% vs.87.5%; p = 0.56). CE incidence was 10.8% (8 out of 74; 95% CI = 5.5% to 19.9%). The odds of having a second trimester loss were significantly higher in the scratch group compared to controls (p = 0.03; OR = infinity; 95% CI = 1.3 to infinity). Endometrial scratching before frozen euploid embryo transfer did not influence pregnancy outcome but increased the chances of second trimester loss. CE was a frequent finding in those undergoing endometrial scratching at the time of retrieval.

Heterogeneity in Fluorescence-Stained Sperm Membrane Patterns and Their Dynamic Changes Towards Fertilization in Mice.

Sperm represent a heterogeneous population crucial for male reproductive success. Additionally, sperm undergo dynamic changes during maturation and capacitation. Despite these well-established processes, the complex nature of sperm heterogeneity and membrane dynamics remains elusive. The composition of phospholipids in the sperm membrane changes dynamically during maturation, with their release occurring during capacitation. This study aims to investigate the heterogeneity and dynamic changes in the sperm membrane during maturation and capacitation towards fertilization by visualizing these membrane dynamics. Sperm were collected from the cauda epididymis or testis of Institute of Cancer Research (ICR) male mice and stained with MemBright dye (commercial name: MemGlow™-560, MG-560), a fluorogenic live-cell membrane probe. Staining was performed either before, during, or after incubation for capacitation. In pre-staining experiments, sperm were stained with MG-560 before capacitation and then incubated to induce capacitation. Acrosome-reacted sperm were assessed after staining with peanut agglutinin FITC (PNA-Lectin FITC). Stained sperm were observed using fluorescence or confocal microscopy. MG-560-stained sperm from the epididymis before capacitation showed four staining patterns: head-midpiece-tail (HMT), head-midpiece (HM), head (H), midpiece (M) positive, or totally negative, with ratios remaining unchanged during capacitation (30.5%, 29%, 11.3%, 3.7%, and 25.5%, respectively). In contrast, all testicular sperm were negative for staining. Pre-stained sperm exhibited an increased number of HM and M patterns over time, whereas the number of HMT-stained sperm decreased. Consistently, spontaneous acrosome-reacted sperm were detected predominantly in HM- or M-stained sperm. After in vitro fertilization (IVF) using pre-stained sperm, zona pellucida-attached sperm were mostly negative for staining. Finally, all sperm detected in the perivitelline space were only negative. Mature sperm membranes stained with MG-560 exhibited heterogeneous and dynamic changes during the capacitation and fertilization process. MG-560 staining identified sperm with the potential to undergo the acrosome reaction, and these MG-560-positive sperm eventually became negative as they penetrated the zona pellucida for fertilization. Thus, the MG-560 staining patterns likely reflect the physiological state and potential of the sperm. These findings provide new insights into sperm heterogeneity and dynamics, and this staining method may also prove useful for assessing sperm quality.

Association of anti-phosphatidylserine/prothrombin antibodies with adverse in vitro fertilization outcomes.

Anti-phosphatidylserine/prothrombin antibodies (aPS/PT) are classified as non-criteria antiphospholipid antibodies (aPL), and are strongly associated with thrombosis and pregnancy complications linked to antiphospholipid syndrome (APS). This study aimed to investigate whether aPS/PT positivity is associated with adverse outcomes in vitro fertilization (IVF). The study included infertile women who tested positive aPS/PT and underwent IVF cycles, as well as infertile controls with pure tubal etiology. We compared the impact of aPS/PT on baseline and clinical characteristics, immune-related indicators, IVF laboratory metrics, and pregnancy outcomes. Women with aPS/PT exhibited lower numbers of retrieved oocytes, embryos, and both perfect and available embryos, as well as reduced rates of blastocyst formation. Furthermore, an imbalanced Th17/Treg ratio and significantly elevated serum IL-17A levels were observed in women with aPS/PT compared to controls. In conclusion, the presence of aPS/PT is associated with adverse IVF and pregnancy outcomes. Early screening for aPS/PT and appropriate consultation for couples undergoing IVF-ET should be considered. Additionally, specific immune and inflammatory mechanisms related to aPS/PT warrant further investigation.

Dual Trigger in IVF—A SWOT Analysis

The typical agent used for final oocyte maturation and resumption of meiosis in in-vitro fertilisation (IVF) has been human chorionic gonadotropin (hCG). This acts as a surrogate for the physiological spontaneous luteinising hormone (LH) surge. Gonadotropin-releasing hormone agonist (GnRH-a) has been used as an alternative trigger in cycles where endogenous LH control is achieved using GnRH-antagonist and has been shown to be an effective method of reducing the risk of OHSS. However, GnRHa trigger is associated with poor corpus luteum function, leading to impaired endometrial receptivity. A combination of a GnRHa and hCG (dual trigger) was proposed to improve IVF cycle outcomes, especially in poor and normo-responder patients. Dual trigger aims to provide a more physiological alternative to HCG-only trigger while obviating some of the problems associated with GnRHa alone. Clinical evidence now supports the value of dual trigger where there has been a previous low proportion of mature eggs or where there is a suboptimal LH response to GnRHa alone. In poor responders, dual triggers could be considered as an effective first line. Dual trigger allows for comparable outcomes in normal and high responders, allowing the possibility of fresh embryo transfer with good clinical pregnancy and live birth rates while minimising OHSS risk.

The Impact of BMI on PCOS Patients and Transcriptome Profiling and Bioinformatic Analysis of Granulosa Cells in PCOS Patients with High and Low BMI.

To explore the impact of high body mass index (BMI) on the embryo quality and clinical outcomes of polycystic ovary syndrome (PCOS) patients, and the possible genes involved. Patients who underwent in-vitro fertilization (IVF) treatment and embryo transfer in our center from November 2014 to September 2023, were divided into low BMI PCOS (LBP) group, high BMI PCOS (HBP) group, and high BMI control (HBC) group. Transcriptome sequencing was performed in eight PCOS patients' granulosa cells (GCs). A total of 812 IVF/intracytoplasmic sperm injection (ICSI) cycles in the embryo part; and 489 fresh, 634 frozen-warmed embryo transfer (FET) cycles from the clinical part were included. The ICSI normal fertilization rate of HBP group was decreased compared to LBP and HBC groups (p = 0.013&0.008). The IVF blastocyst development rate in HBP group was lower than LBP group (p = 0.01). The preterm birth rate in HBP group was higher than in LBP (30.66% vs. 16.48%, p = 0.041) and HBC groups (30.66% vs. 11.34%, p = 0.002), the adjusted OR (AOR) of preterm birth and BMI was 1.124 (p = 0.023) in FET cycles. Transcriptome sequencing result of GCs showed that differentially expressed miRNAs/lncRNA/circRNA/mRNAs in two PCOS groups were 61, 450, 83, and 568, respectively. The hub genes analysis, enrichment analysis and competing endogenous RNA network revealed that cell cycle, oocyte maturation, systemic lupus erythematosus, oxidative phosphorylation, and mitogen-activated protein kinases (MAPK) signaling pathways had important roles in the embryo development and pregnancy process. The combined effect of PCOS and obesity reduced oocyte quality and embryonic development potential, finally led to poorer clinical outcomes.

Increased apoptosis in late-developing in vitro fertilized bovine blastocysts decreases successful pregnancy.

Pregnancy in cattle after embryo transfer (ET) is influenced by several factors, including embryo quality. Therefore, preparing high-quality embryos with the greatest developmental potential is essential for achieving a successful pregnancy after ET. Meanwhile, blastocysts produced by in vitro fertilization (IVF) procedure have different developmental speed during in vitro culture (IVC) and they exhibited different competence in the establishment of pregnancy. This study aimed to identify the comparative features of early-, mid-, and late-developing bovine IVF blastocysts, when they first appeared at Day 7, 8, and 9 during IVC, respectively. In addition, the correlations between their molecular features and pregnancy ability were analyzed. The results showed no difference in the morphological characteristics, including total cell count and diameter, between the Day 7, 8, and 9 blastocysts. However, the pregnancy rate post-ET was significantly different between the groups at 51.7%, 36.7%, and 17.8% for Day 7, 8, and 9 blastocysts, respectively. During early embryo development, late-developing blastocysts demonstrated a reduced cell count in the inner cell mass and decreased expression of the early embryo developmental genes (Oct4 and Sox2) compared with the early- and mid-developing blastocysts. In addition, the number of apoptotic cells and apoptosis-related gene expression (increased Bax and decreased Bcl2) gradually elevated from the Day 7 to Day 9 blastocysts. However, there was no difference in mitochondrial activity and mitochondria-relevant gene expression (Tfam and Cox1) between the groups. Correlation analysis identified a significantly negative correlation between the pregnancy rate and the blastocysts' degree of apoptosis, indicating that the low pregnancy ability of late-developing blastocysts was mainly caused by increased apoptosis. This study's results may contribute to the field of animal biotechnology by assisting in establishing an improved strategy for bovine ET with IVF embryos.

The clinical value of short-term insemination: a retrospective analysis of 3496 patients

BackgroundThe safety and effectiveness of short-term insemination remain a subject of controversy. This study aims to investigate the impact of short-term insemination on both embryo quality and pregnancy outcomes and whether it is necessary to apply short-term insemination to all patients underwent in vitro fertilization (IVF).MethodsA retrospective analysis was conducted on 3,496 patients from two centers over the period January 2016 to December 2022. Of these, 1307 patients underwent IVF, 1656 patients were treated with short-term IVF, 166 patients received early rescue intracytoplasmic sperm injection (R-ICSI) and 367 patients were treated with ICSI. The clinical and neonatal outcomes were compared between the two groups.ResultsThe rate of high-quality embryos was significantly lower in the short-term IVF group compared to the routine IVF group (59.89% vs. 68.16%) (P = 0.000), the rate of blastocyst formation was significantly lower in the short-term IVF group compared to the routine IVF group (44.99% vs. 61.34%) (P = 0.000). There were no significant differences in clinical outcomes or neonatal outcomes between the two groups, irrespective of whether fresh or frozen embryos were used (both P > 0.05). The incidence of ≥ 3PN demonstrated no significant difference between the early R-ICSI and ICSI groups (1.04% vs. 0.66%) (P = 0.114), furthermore, the clinical outcomes were similar in both groups, for both fresh and frozen embryos (both P > 0.05).ConclusionsFor patients with primary fertility, short-term IVF combined with early R-ICSI can effectively prevent potential low fertilization or fertilization failure, reduce the risk of patients with no transferable embryo, avoid the waste of resources and had no adverse effects on neonatal outcomes. However, short-term IVF reduced the oocytes utilization rate in one single oocyte pick-up cycle, for patients with no risk factors for fertilization failure, the overnight fertilization is still one of the most important ways of insemination worthy of affirmation.Trial registrationNA.

Association of insulin resistance surrogates with live birth outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization

BackgroundInsulin resistance (IR) is a common pathophysiologic feature in patients with polycystic ovary syndrome (PCOS). However, there have been no studies investigating the association of IR surrogates with pregnancy outcomes in women with PCOS undergoing in vitro fertilization (IVF). Therefore, we explored the association between these factors among PCOS patients.MethodsWe conducted a retrospective study that included patients with PCOS who underwent IVF at a university-affiliated hospital. Blood samples and physical examinations are collected at reproductive center on fasting in the morning of the 2nd to 4th day of the menstrual cycle prior to medication. We categorized participants into “Non-IR group” (HOMA-IR < 2.2) and “IR group” (HOMA-IR ≥ 2.2). The association of IR surrogates [triglyceride-glucose-body mass index (TyG-BMI), triglyceride-glucose (TyG) and homeostasis model assessment (HOMA-IR)] with IVF outcomes was evaluated by regression model analysis. Moreover, we also performed sensitivity analyses with stratification and interaction tests. The primary outcome variable was the live birth rate.ResultsA total of 543 PCOS patients were finally included in the study. In all three regression models for the fresh embryo transfer (ET) cycles, all three IR surrogates showed stable negative correlations with live birth rate (in Model III: TyG-BMI OR = 0.99, 95% CI: 0.98 ~ 0.99; TyG OR = 0.47, 95% CI: 0.27 ~ 0.82; HOMA-IR OR = 0.84, 95% CI: 0.72 ~ 0.97; all P < 0.05), and this association was stable across all subgroups of the population (all P-interaction > 0.05). However, this relationship did not exist in frozen-thawed embryo transfer (FET) cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles [TyG-BMI: 0.64 (95% CI: 0.58, 0.69) vs. TyG: 0.61 (95% CI: 0.55, 0.67) vs. HOMA-IR: 0.60 (95% CI: 0.55, 0.67)].ConclusionsOur study revealed that the three IR surrogates (TyG-BMI, TyG and HOMA-IR) were negatively associated with the live birth rates in fresh ET cycles. However, this relationship did not exist in FET cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles.

Prolonged Ovarian Stimulation Does Not Worsen Neonatal Outcomes After Fresh Embryo Transfers.

To investigate the relationship between prolonged ovarian stimulation and neonatal outcomes after autologous fresh embryo transfer (fET). A retrospective cohort study. University-affiliated centres. 3529 patients underwent autologous invitro fertilisation (IVF) cycles between August 1, 2016 and December 31, 2022, with a live singleton birth after fET. Univariate and multivariate regression analyses were used to determine the relationship between prolonged ovarian stimulation and neonatal outcomes. Propensity score matching (PSM) was applied to evaluate independent effects. Neonatal outcomes. Multivariate regression showed no significant association between simulation duration and birthweight (adjusted β: 4.19, 95% confidence interval [CI]: -13.86 to 22.23; p = 0.6494) or gestational age (GA) (adjusted β: -0.01, 95% [CI]: -0.09 to 0.06; p = 0.7403) Categorical analysis of neonatal outcomes, including low birthweight (LBW) (adjusted Odds Ratio [OR]: 0.94, 95% [CI]: 0.70 to 1.25; p = 0.6501), macrosomia (adjusted OR: 0.95, 95% [CI]: 0.78 to 1.16; p = 0.6294), small for gestational age (SGA) (adjusted OR: 0.95, 95% [CI]: 0.75 to 1.19; p = 0.6465), large for gestational age (LGA) (adjusted OR: 1.02, 95% [CI]: 0.85 to 1.21; p = 0.8542) and preterm (adjusted OR: 0.93, 95% [CI]: 0.77 to 1.11; p = 0.4191), revealed no associations with stimulation duration. PSM analysis confirmed these findings. Prolonged ovarian stimulation does not appear to increase adverse neonatal outcomes in singleton newborns after autologous fET.

Artificial intelligence-driven analysis of embryo morphokinetics in singleton, twin, and triplet pregnancies.

In recent years, the transfer of more than one embryo has become less frequent to diminish multiple pregnancies. Even so, there is still a risk of one embryo splitting into two or even three. This report presents the case of a triamniotic monochorionic gestation in a 35-year-old woman, obtained after the transfer of a single day 5 embryo that had been previously hatched with a laser and subsequently transferred in a fresh IVF cycle. The morphokinetics of this embryo as well as another eight that produced monozygotic twins were compared with nine embryos that achieved singleton gestations. An artificial intelligence (AI) system was used to perform this analysis objectively. Embryo divisions leading to multiple gestations were slower across all analysed parameters. This was most evident in the time taken to reach the 5-cell stage (t5) (48.74 ± 3.21 versus 44.69 ± 5.61 h) and the morula stage (tM) (85.08 ± 10.00 versus 78.13 ± 5.35 h). Moreover, blastocyst diameter (161.80 ± 26.50 versus 179.10 ± 25.88 μm) and area (21684 ± 7267.4 versus 26516 ± 7254.8 μm2) were smaller in these embryos, but the differences did not reach statistical significance. This is the first report, to our knowledge, to use AI to analyse and compare morphokinetic parameters between singleton pregnancies and a group of embryos that produced twin and triplet pregnancies.

Morphokinetic Analyses of Fishing Cat-Domestic Cat Interspecies Somatic Cell Nuclear Transfer Embryos Through A Time-Lapse System.

A time-lapse live embryo monitoring system provides a powerful approach to recording dynamic developmental events of cultured embryos in detail. By obtaining continuous short-interval images, blastocyst formation can be predicted and embryos can be selected. The objective of this study was to investigate the morphokinetic parameters of fishing cat-domestic cat interspecies somatic cell nuclear transfer (iSCNT) embryos from one-cell to blastocyst stages, and in particular, the cleavage patterns of the first division in iSCNT and IVF embryos, as these play a central role in euploidy. Domestic cat in vitro fertilization (IVF) embryos were set up as controls. The results show that morula and blastocyst development rates were significantly lower in the iSCNT embryos compared to their IVF counterparts. All earlier time points of embryonic development before the onset of blastulation in the iSCNT embryos were significantly delayed when compared with their IVF counterparts. In iSCNT, normal embryos (defined as those that developed to the blastocyst stage) took a longer time to reach the morula stage, and these morulas were more likely to undergo compaction, compared to their arrested embryo counterparts. Direct cleavage in the first division is a morphological aberration, and was seen with greater prevalence in iSCNT embryos than control IVF embryos; these aberrant embryos displayed a significantly lower blastocyst development rate than embryos that had undergone normal cleavage. In conclusion, the morphokinetic parameters of fishing cat-domestic cat iSCNT embryos at early stages could be used to predict their potential for development to the blastocyst stage. A time-lapse imaging system is potentially a powerful tool for selecting early embryos with developmental potential for transfer, and hence, for improving feline iSCNT efficiency.

Sperm vitrification in horses and donkeys.

Sperm vitrification is an alternative freezing method, which includes high cooling rates and non-permeable cryoprotectants agents. The first attempt in equids was using the spheres technique by directly dropping small volumes of the sperm into liquid nitrogen. Later, vitrification was developed using 0.25 mL straws with outer covers, which resulted in similar progressive motility when compared to conventional freezing in donkeys (44.3 ± 15.0 % vs. 44.7 ± 18.2 %) or even higher in horses (48.2 ± 2.3 % vs. 37.3 ± 2.2 %). Subsequently, the vitrification of larger volumes of sperm in 0.5 mL straws was evaluated, but the results showed poor sperm quality after different warming procedures. Finally, fertility was assessed in vitro and in vivo. In horses, the sperm fertilizing capacity was assessed utilizing heterologous in vitro fertilization (IVF) and vitrified sperm showed the ability to penetrate cattle oocytes, leading to pronuclear formation and hybrid embryo cleavage. In donkeys, fertility trials were conducted in vivo on a small group of jennies, showing no statistically significant difference in pregnancy rates between artificial insemination (AI) with vitrified semen (22%) or frozen semen (10%); however, the uterine inflammatory response after AI with vitrified semen solved faster than frozen semen. In conclusion, sperm vitrification has been optimized in horses and donkeys using 0.25 mL straws with outer covers and can be considered as an alternative to conventional freezing.

ERK activation dynamics in maturing oocyte controls embryonic nuclear divisions in Caenorhabditis elegans.

ERK activity oscillates between sustained activation during oocyte formation and transient inactivation during oocyte maturation, fertilization, and early embryogenesis. Consequences of ectopic ERK activity upon oocyte maturation and in early embryogenesis are unknown. We show, in Caenorhabditis elegans, that ectopic ERK activity upon oocyte maturation (metaphase I oocytes) results in embryos with abnormalities in nuclear divisions leading to embryonic death. We uncover that ERK directly phosphorylates Polo-like kinase I (PLK-1), on Serine 404, to inhibit nuclear envelope breakdown (NEBD) in early embryogenesis. The RAS/ERK/PLK-1 pathway poisons zygotic NEBD and inhibits the merging of parental genomes, underlining the importance of turning off ERK prior to embryogenesis. Given the conserved nature of both ERK signaling to oocyte development and PLK1 to embryonic divisions, this work has implications for women undergoing invitro fertilization (IVF) where ectopic ERK activation during superovulation through hormonal stimulation may diminish oocyte quality and influence zygotic development.

The perception of artificial intelligence and infertility care among patients undergoing fertility treatment.

To characterize the opinions of patients undergoing infertility treatment on the use of artificial intelligence (AI) in their care. Patients planning or undergoing in vitro fertilization (IVF) or frozen embryo transfers were invited to complete an anonymous electronic survey from April to June 2024. The survey collected demographics, technological affinity, general perception of AI, and its applications to fertility care. Patient-reported trust of AI compared to a physician for fertility care (e.g. gamete selection, gonadotropin doing, and stimulation length) were analyzed. Descriptive statistics were calculated, and subgroup analyses by age, occupation, and parity were performed. Chi-squared tests were used to compare categorical variables. A total of 200 patients completed the survey and were primarily female (n = 193/200) and of reproductive age (mean 37years). Patients were well educated with high technological affinity. Respondents were familiar with AI (93%) and generally supported its use in medicine (55%), but fewer trusted AI-informed reproductive care (46%). More patients disagreed (37%) that AI should be used to determine gonadotropin dose or stimulation length compared to embryo selection (26.5%; p = 0.01). In the setting of disagreement between physician and AI recommendation, patients preferred the physician-based recommendation in all treatment-related decisions. However, a larger proportion favored AI recommendations for gamete (22%) and embryo (14.5%) selection, compared to gonadotropin dosing (6.5%) or stimulation length (7.0%). Most would not be willing to pay more for AI-informed fertility care. In this highly educated infertile population familiar with AI, patients still prefer physician-based recommendations compared with AI.

Combined Input Deep Learning Pipeline for Embryo Selection for In Vitro Fertilization Using Light Microscopic Images and Additional Features.

The current process of embryo selection in in vitro fertilization is based on morphological criteria; embryos are manually evaluated by embryologists under subjective assessment. In this study, a deep learning-based pipeline was developed to classify the viability of embryos using combined inputs, including microscopic images of embryos and additional features, such as patient age and developed pseudo-features, including a continuous interpretation of Istanbul grading scores by predicting the embryo stage, inner cell mass, and trophectoderm. For viability prediction, convolution-based transferred learning models were employed, multiple pretrained models were compared, and image preprocessing techniques and hyperparameter optimization via Optuna were utilized. In addition, a custom weight was trained using a self-supervised learning framework known as the Simple Framework for Contrastive Learning of Visual Representations (SimCLR) in cooperation with generated images using generative adversarial networks (GANs). The best model was developed from the EfficientNet-B0 model using preprocessed images combined with pseudo-features generated using separate EfficientNet-B0 models, and optimized by Optuna to tune the hyperparameters of the models. The designed model's F1 score, accuracy, sensitivity, and area under curve (AUC) were 65.02%, 69.04%, 56.76%, and 66.98%, respectively. This study also showed an advantage in accuracy and a similar AUC when compared with the recent ensemble method.

Relation of Follicular Fluid Soluble Receptor for Advanced Glycation End-Products Concentration and Anti Mullerian Hormone in Polycystic Ovary Syndrome and Non-PCOS Women Referring to In Vitro Fertilization Center: Case-Control Study.

Reproductive dysfunctions of polycystic ovary syndrome (PCOS) and blood anti-mullerian hormone (AMH) concentration are significantly influenced by the dietary advanced glycation end products (AGEs). The interplay between AGEs and their soluble form of receptor, might exert a protective role on the follicular environment and affect AMH concentration. This study investigated the relationship between soluble receptor for advanced glycation end-products (sRAGE) levels in follicular fluid (FF) and serum AMH levels in PCOS and non-PCOS women. Among 43 women of reproductive age who participated in this case-control study 26 non- PCOS women were assigned to the control group, while 17 participants were diagnosed with PCOS and allocated to the case group. Prior to the in vitro fertilization (IVF) procedure, fluid samples were collected and levels of FF sRAGEs and serum AMH were recorded through the use of commercially available ELISA kits. Correlation analysis, without age adjusting, revealed a statistically considerable and positive association between FF sRAGE and serum AMH concentration in PCOS women (P=0.012, r=0.596). Moreover, after age stratification, the same pattern was observed in some age groups; in PCOS women aged 40 years or older (r=1, P<0.001), as well as those younger than 30 years (r=0.922, P=0.003), correlation analysis demonstrated a significant and positive relationship between FF sRAGE and serum AMH levels. The association between sRAGE and AMH in women with PCOS is primarily affected by their age, whereas non-PCOS women showed no relationship. The results show that the levels of these receptors (sRAGE) show their specific effects in young women and women over 40 years old and not in middle age and target the ovarian reserve. It seems to act as a defensive shield in older women and increase fertility in young women.

Comparison of Pregnancy Associated Plasma Protein A (PAPP-A) Levels in IVF-Induced Pregnancies and Physiological Pregnancies: A Case- Control Study

Introduction: Infertility is an important issue in reproductive health. In the field of reproductive medicine, In vitro Fertilization (IVF) stands out as a central approach to helping infertile couples. Pregnancy-associated Plasma Protein-A (PAPP-A) levels increase progressively throughout pregnancy until delivery. Therefore, the present study aimed to conduct a detailed examination and comparison of PAPP-A levels between women who have undergone IVF treatment due to infertility and those with natural pregnancies, all of whom have been referred to the Gynecology and Infertility Clinic of Besat Hospital in 2020. Methods: The present case-control study was conducted on women with IVF-induced pregnancies and those with physiological pregnancies who have been referred to the Gynecology and Infertility Clinic of Besat Hospital in 2020. Pregnant women who did not have a complete medical record and had a history of other diseases were excluded from the study. In this study, venous blood was collected from the pregnant women, and the serum level of the PAPP-A marker was checked. This information was recorded in their medical records and then subjected to statistical analysis. Results: For this purpose, 28 pregnant women by IVF and 34 physiological pregnant women were included in the study. There was a significant relationship between the type of pregnancy (IVF and physiological pregnancy) and the serum level of PAPP-A dispersion based on the KID test, and 70.59% of pregnancies were physiological at the level of 0.5-0.9. Based on the results of the ROC curve test, the cut-off point of the serum level of PAPP-A in pregnancy caused by IVF and physiological pregnancy was 0.63. This means that in 90.91% of people whose serum level of PAPP-A was less than 0.63, the method of pregnancy was IVF. Conclusion: The results of the present study have revealed the serum level of PAPP-A to be different depending on the type of pregnancy, and it has been found to be significantly higher in pregnant women with physiological pregnancy than in pregnancy due to IVF.

FERTILITY CARE IN LOW AND MIDDLE INCOME COUNTRIES: Embryologists' practices of care in IVF-clinics in sub-Saharan Africa.

Despite the centrality of the role of embryologists in in vitro fertilization (IVF), there is relatively little literature on the nature of their work. In this article, we draw on results from a large ethnographic study on the emerging IVF industry in South Africa and reproductive travel in sub-Saharan Africa (SSA), where IVF clinics and embryologists are scarce. Drawing on qualitative interviews with 11 embryologists, who work(ed) in SSA, we illustrate how their care practices are produced through the interaction of people and things. We emphasize the importance of context in shaping their practices, including the shortage of embryologists, the need to set up 'first' clinics in their respective countries, the paucity of trained counsellors in clinics and the mobility of IVF staff. The embryologists we interviewed performed multiple tasks on top of their laboratory work, including entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. They enacted care in several ways, towards gametes and embryos, patients, clinics and the profession. These multiple tasks and care practices make for dynamic and fulfilling careers of the interviewed embryologists but also stretch their capacities. They also raise questions about their contribution to the scarcity of embryological work in SSA. If access to IVF is to be achieved in the SSA region, more embryologists need to be trained and retained. Embryologists play a central role in IVF. Yet, there is limited knowledge about the nature of their work. We examine the work of embryologists in SSA, where IVF clinics and embryologists are scarce. Based on qualitative interviews conducted with 12 embryologists, we illustrate the multiple tasks they perform on top of their laboratory work: entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. Context is important in shaping these practices. This includes the shortage of embryologists in the SSA region, the need to set up 'first' clinics in their respective countries, the lack of trained counsellors in clinics and the mobility of IVF staff. These multiple tasks, while professionally fulfilling, raise questions about their contribution to the scarcity of embryological work in SSA, which contributes to the limited access to IVF in this region.

Assessing Willingness to Pay for IVF Among Infertile Women in Greece: A Single-Center Case Study.

In recent years, In Vitro fertilization (IVF) science has grown by leaps and bounds in the field of assisted reproduction, helping millions of couples worldwide. The aim of this study is to examine the extent to which infertile women are willing to pay for IVF services in Greece. Through the distribution of questionnaires, willingness to pay (WTP) is recorded according to IVF success rates, and the relationship between WTP and the respondents' demographic characteristics is analyzed. Subjects were divided into two groups according to age and were given a hypothetical scenario, according to the contingent valuation approach. The majority of women were reluctant to pay the amount of money corresponding to the average cost of an IVF cycle in Greece. In particular, participants replied that the amount they would be willing to pay is only one-third of the indicative amount of €6000. Moreover, WTP is not influenced by the professional status or educational level of the participating women. This study highlights the financial barriers many couples face when pursuing assisted reproduction. If the average cost of IVF were lower, infertile women would be willing to undergo more IVF cycles if necessary. This finding has important implications for the valuation of IVF services and the development of pricing policies to enhance affordability and accessibility. Policymakers must consider reforms that balance the cost of IVF with its societal benefits. By incorporating this aspect into pricing and policy decisions, Greece can improve the accessibility of IVF services and ensure equitable treatment opportunities for all concerned individuals.

Microbiological contamination in IVF laboratories: A narrative review

In vitro fertilization (IVF) is one of the most used assisted reproductive technology (ART) techniques today. However, the success of IVF procedures heavily relies on maintaining a sterile environment in laboratories. This narrative review examines the effects of microbiological contamination in IVF laboratories, exploring its sources, impacts on IVF outcomes, and preventive measures. We conducted a complete literature search using databases such as PubMed and Google Scholar, focusing on studies published within the last fifteen years. Our findings highlight that microbiological contamination can significantly impair embryo quality, reduce implantation and pregnancy rates, and increase the risk of miscarriage and infection. The review also discusses current best practices for contamination prevention and identifies areas for future research. This work emphasizes the critical importance of stringent sterility protocols in IVF laboratories and calls for continued vigilance and innovation in maintaining optimal conditions for assisted reproduction.